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Images in Neurology |

Magnetic Resonance Imaging–Based Intravenous Thrombolysis 6 Hours After Onset of Minor Cerebellar Stroke

Florent Gobert, MD; Tae-Hee Cho, MD; Jean Philippe Desilles, MD; Marc Hermier, MD, PhD; Laura Mechtouff, MD; Laurent Derex, MD, PhD; Norbert Nighoghossian, MD, PhD
Arch Neurol. 2011;68(5):678. doi:10.1001/archneurol.2011.87.
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Intravenous thrombolysis in an extended time window has been proposed in anterior circulation stroke based on the presence of a mismatch between the diffusion and perfusion lesions on magnetic resonance imaging (MRI).1 A single report discussed this strategy in patients presenting beyond 4.5 hours with a minor posterior circulation stroke.2 We describe a patient with vertebrobasilar stroke treated 6 hours after symptom onset, using the diffusion-perfusion mismatch paradigm.

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Magnetic resonance imaging (MRI) was performed at baseline and day 1. A, Axial diffusion MRI at baseline. Arrowhead indicates left lateral mesencephalic and cerebellar lesions. B, Perfusion MRI time-to-peak map at baseline. Arrow indicates cerebellar diffusion-perfusion mismatch. C, Time-of-flight magnetic resonance angiogram at baseline. Arrow indicates left superior cerebellar artery occlusion. D, Axial diffusion MRI on day 1. Arrow indicates mesencephalic diffusion lesion reversal; arrowheads, new cerebellar lesions. E, Perfusion MRI time-to-peak map on day 1. Arrow indicates significant reperfusion. F, Time-of-flight magnetic resonance angiogram on day 1. Arrow indicates recanalization of the proximal left superior cerebellar artery.

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